1. Field of the Invention
The present invention relates to a gas insufflation apparatus and more particularly to a gas insufflation apparatus which is used with an arthroscopic attachment of a hand-held CO.sub.2 laser system arthroscopic attachment in order to distend a knee joint during arthroscopic surgery.
2. Description of the Prior Art
In their article, entitled "Laser Energy in Arthroscopic Meniscectomy," published in Orthopedics, Volume 6, Number 9, pages 1165-1169, Sept., 1983, Terry L. Whipple, Richard B. Caspari and John F. Meyers discussed the rationale and technique for performing arthroscopic meniscectomy with a carbon dioxide laser. They distended the knee joint with either nitrogen or carbon dioxide through the sleeve of the arthroscope via a gas infusion pump, which maintained the intraarticular pressure in the range of 80 to 100 mm Hg. Before they introduced the laser cannula through a separate portion, they switched the gas infusion to the laser cannula in order to prevent particulate or liquid from entering the laser cannula.
U.S. Pat. No. 4,369,768, entitled Arthroscope, issued to Marko Vukovic on Jan. 25, 1983, teaches an arthroscope.
On Oct. 11, 1983 Chadwick F. Smith and Leroy V. Sutter, Jr. filed an application, entitled An Arthroscopic Introducer for Use with a Laser System, having Ser. No. 540,298, described an arthroscopic introducer. A laser system is optically and mechanically coupled to the arthroscopic introducer so that the arthroscopic introducer may be used surgically under arthroscopic control. The arthroscopic introducer includes a gas inlet for letting a gas into the arthroscopic introducer and a lens focusing system for focusing the beam of light energy into an optical nozzle which functions as a high pressure gas nozzle.
In their article, entitled "The Use of Laser Beams for Operations in Haemophilia," published in The Scandinavian Journal of Haemotology in 1984, Supplementum 40, Volume 33, pages 281-289, 1984 F. Hefti, E. Morscher and F. Koller used a Sharplan 791 CO.sub.2 Surgical Laser to perform five synovectomies of the knee joint, four synovectomies of the elbow joint and one splitting of the retinaculum of the knee joint.
U.S. Pat. No. 3,865,113, entitled Laser Device Particularly Useful as Surgical Scalpel, issued to Uzi Sharon and Isaac Kaplan on Feb. 11, 1975, teaches a laser beam manipulator including a tube which is optically coupled through an articulated arm to a CO.sub.2 laser system and beam targeting member which is carried by the tube.
U.S. Pat. No. 3,710,798, entitled Laser System for Microsurgery, issued to Herbert C. Bredemeier on Jan. 16, 1973, teaches a laser system for microsurgery which includes a mirror for changing the direction of a beam of light energy from a CO.sub.2 laser system and directing the beam to the treatment site.
U.S. Pat. No. 3,982,541, entitled Eye Surgical Instrument, issued to Francis A. L'Esperance on Sept. 28, 1976, teaches a method of surgically removing body tissue which includes the steps of contacting the body tissue with a probe open at a free end, passing a CO.sub.2 laser beam through a central passage in the probe and the open end to the tissue at a power level sufficent to affect vaporization of tissue, vaporizing only the surface portion of the tissue exposed to the CO.sub.2 laser beam in a manner so that the vaporizing step is surface phenomena at a depth not more than about 0.33 millimeters, introducing a gas stream into the probe downstream from the lenses associated with the CO.sub.2 laser beam, passing the gas stream through the probe in a direction towards the free end of the probe and out of the probe, and removing smoke and any vaporized portion of the tissue through the probe by way of the gas stream.
U.S. Pat. No. 3,982,533, entitled Insufflation Apparatus, issued to F. M. Wiest on Sept. 28, 1976, teaches an apparatus for introducing limited quantities of carbon dioxide into the human body for operational purposes, particularly laparoscopy. The insufflation apparatus includes a control device for delivering the carbon dioxide, a connecting nipple on the control device for connecting a first flexible tubing to a first operative cannula of a dual Veress needle introducable into the body and a pressure gauge for indicating the pressure present in the body cavity. The insufflation apparatus also includes a second connection nipple which is disposed on the control device and which is connected by a nipple to a pressure gauge. The second connection nipple is connected by a second flexible tubing to a second coaxial cannula of the dual Veress needle so that the pressure gauge is directly connected with the body cavity rather through the first cannula of the dual Veress needle.
U.S. Pat. No. 4,048,992, entitled Insufflator, issued to Hans-Joachin Lindemann and F. M. Wiest on Sept. 20, 1977, teaches an apparatus for introducing limited quantities of carbon dioxide into the human body for operational purposes, particularly laparoscopy or hysteroscopy. The insufflation apparatus includes two pressure reducers, in series, followed by a gas flow monitoring device through which carbon dioxide is directed from a gas supply to a human body. The two pressure reducers are constantly adjusted to fixed gas supply pressures. The gas flow monitoring device includes a cylindrical expansion container which has a central inlet port and a large diameter, and in whose peripheral zone the gas flow velocity approaches a zero rate. First and second sensing elements for the measured variable are provided in the expansion container. The first sensing element is located immediately in the area of the inlet port and the second sensing element is located close to the cylindrical side wall at the maximum possible radial spacing from the first sensing element. The two sensing elements are included in a measuring bridge and a measuring amplifier is connected to the bridge output. An indicator of the rate of flow is connected to the amplifier output. The second pressure reducer may be adjusted to a supply pressure in the range of 15 to 200 mm Hg.
U.S. Pat. No. 4,207,887, entitled Gas Insufflation Apparatus, issued to Siegfried Hiltebrandt and Helmut Wurster on July 17, 1980, teaches a gas insufflation apparatus which introduces limited quantities of carbon dioxide into a body cavity for operational purposes, particularly laparoscopy or hysteroscopy. The gas insufflation apparatus includes a compressed gas cylinder containing carbon dioxide, the pressure of which is controlled and monitored by a first pressure gauge and a first pressure regulator in series. From the first pressure regulator the gas flows at reduced pressure via a shut-off valve to an intermediate container the pressure and quantity of gas in which can be read off a second pressure gauge. The container also has a safety valve. The reduced-pressure insufflation gas from the container flows through a second pressure regulator which is advantageously continuously adjustable and by means of which the desired gas pressure in a body cavity required by a particular patient can be preselected. The regulated pressure can be monitored by a third pressure gauge. To inject a volume of gas into the body cavity, a valve downstream of the second pressure regulator is opened manually so that the gas will then flow to the body cavity via a rate of flow controller, an insufflation duct and a tube constituted by the cannula. The preselected pressure is maintained by the second pressure regulator.
U.S. Pat. No. 3,709,214, entitled Gas Orburating Method, issued to Jack R. Robertson on Jan. 9, 1973, teaches a method of diagnosis and/or therapy of an internal part of the body which accessible from an adjacent body opening which includes the step introducing a gas under pressure.
U.S. Pat. No. 4,550,240, entitled Laser Irradiating Apparatus, issued to Masahiro Toida and Norihiro Suenaga and Nobuyuki Suenaga on Oct. 29, 1985, teaches a laser irradiating apparatus which includes first and second light guides for two laser beams at a first wavelength and a second wavelength, respectively, and first and second supply for a first assist gas and a second assist gas.
U.S. Pat. No. 3,885,590, entitled Gas Transmission and Monitoring Device, entitled to John L. Ford on May 27, 1975, teaches a compact self-contained flow and pressure regulator device which transmits and monitors gas from a source of compressed gas to a body cavity during surgery. The device includes a selectively adjustable pressure regulator which controls the gas received from the compressed gas source, a limiting orifice to attenuate the flow rate and an off-on valve. The device also includes an adjustable pressure valve which controls the discharge gas pressure, a gauge which indicates the discharge gas pressure, and a safety relief valve.